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MDCT features in the differentiation of T4a gastric cancer from less-advanced gastric cancer: significance of the hyperattenuating serosa sign.

ABSTRACT: OBJECTIVE: The purpose of our study was to evaluate CT findings to differentiate between T4a and less advanced gastric cancers. METHODS: The institutional review board approved this study and waived informed consent. This study included 228 retrospectively identified patients with surgically confirmed gastric cancer (138 T1, 25 T2, 24 T3 and 41 T4a) and who had also undergone pre-operative CT scan. Transverse and multiplanar reconstruction scans were reviewed in consensus by two other blinded radiologists. The following CT findings that differentiate T4a from less advanced cancers were evaluated: nodular or an irregular outer layer of the gastric wall, haziness of the perigastric fat and a hyperattenuating serosa sign. The CT features of T4a and less advanced gastric cancers were compared by means of univariate and multivariate analyses. RESULTS: In univariate analysis, nodular or an irregular outer layer of the gastric wall, haziness of the perigastric fat and the hyperattenuating serosa sign were significant in differentiation between T4a and less advanced gastric cancers. In addition, nodular or an irregular outer layer of the gastric wall and the hyperattenuating serosa sign were significant in differentiation between T3 and T4a. In multivariate logistic analysis, the hyperattenuating serosa sign was the most significant finding in differentiation between T3 and T4a (odds ratio, 4.210; 95% confidence intervals, 1.581-11.214; p=0.004). CONCLUSION: The hyperattenuating serosa sign may be a useful CT finding in differentiation between T4a and less-advanced gastric cancers. ADVANCES IN KNOWLEDGE: The hyperattenuating serosa sign is associated with gastric cancer with invading the serosa and can facilitate planning of the optimal pre-operative evaluation and treatment.

SUBMITTER: Kim TU

PROVIDER: S-EPMC3755399 | biostudies-other | 2013 Sep

REPOSITORIES: biostudies-other

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Project description:BackgroundThe differentiation status of gastric cancer is related to clinical stage, treatment and prognosis. It is expected to establish a radiomic model based on the combination of gastric cancer and spleen to predict the differentiation degree of gastric cancer. Thus, we aim to determine whether radiomic spleen features can be used to distinguish advanced gastric cancer with varying states of differentiation.Materials and methodsJanuary 2019 to January 2021, we retrospectively analyzed 147 patients with advanced gastric cancer confirmed by pathology. The clinical data were reviewed and analyzed. Three radiomics predictive models were built from radiomics features based on gastric cancer (GC), spleen (SP) and combination of two organ position (GC+SP) images. Then, three Radscores (GC, SP and GC+SP) were obtained. A nomogram was developed to predict differentiation statue by incorporating GC+SP Radscore and clinical risk factors. The area under the curve (AUC) of operating characteristics (ROC) and calibration curves were assessed to evaluate the differential performance of radiomic models based on gastric cancer and spleen for advanced gastric cancer with different states of differentiation (poorly differentiated group and non- poorly differentiated group).ResultsThere were 147 patients evaluated (mean age, 60 years ± 11SD, 111 men). Univariate and multivariate logistic analysis identified three clinical features (age, cTNM stage and CT attenuation of spleen arterial phase) were independent risk factors for the degree of differentiation of GC (p =0.004,0.000,0.020, respectively). The clinical radiomics (namely, GC+SP+Clin) model showed powerful prognostic ability in the training and test cohorts with AUCs of 0.97 and 0.91, respectively. The established model has the best clinical benefit in diagnosing GC differentiation.ConclusionBy combining radiomic features (GC and spleen) with clinical risk factors, we develop a radiomic nomogram to predict differentiation status in patients with AGC, which can be used to guide treatment decisions.

Project description:AimTo investigate clinicopathological features of early stage gastric cancer with enteroblastic differentiation (GCED).MethodsWe retrospectively investigated data on 6 cases of early stage GCED and 186 cases of early stage conventional gastric cancer (CGC: well or moderately differentiated adenocarcinoma) who underwent endoscopic submucosal dissection or endoscopic mucosal resection from September 2011 to February 2015 in our hospital. GCED was defined as a tumor having a primitive intestine-like structure composed of cuboidal or columnar cells with clear cytoplasm and immunohistochemical positivity for either alpha-fetoprotein, Glypican 3 or SALL4. The following were compared between GCED and CGC: age, gender, location and size of tumor, macroscopic type, ulceration, depth of invasion, lymphatic and venous invasion, positive horizontal and vertical margin, curative resection rate.ResultsSix cases (5 males, 1 female; mean age 75.7 years; 6 lesions) of early gastric cancer with a GCED component and 186 cases (139 males, 47 females; mean age 72.7 years; 209 lesions) of early stage CGC were investigated. Mean tumor diameters were similar but rates of submucosal invasion, lymphatic invasion, venous invasion, and non-curative resection were higher in GCED than CGC (66.6% vs 11.4%, 33.3% vs 2.3%, 66.6% vs 0.4%, 83.3% vs 11% respectively, P < 0.01). Deep submucosal invasion was not revealed endoscopically or by preoperative biopsy. Histologically, in GCED the superficial mucosal layer was covered with a CGC component. The GCED component tended to exist in the deeper part of the mucosa to the submucosa by lymphatic and/or venous invasion, without severe stromal reaction. In addition, Glypican 3 was the most sensitive marker for GCED (positivity, 83.3%), immunohistochemically.ConclusionEven in the early stage GCED has high malignant potential, and preoperative diagnosis is considered difficult. Endoscopists and pathologists should know the clinicopathological features of this highly malignant type of cancer.

Project description:To evaluate the biopathologic features and clinical significance of nodal micrometastasis (MI) in early gastric cancer (EGC).Among 1022 EGC patients who underwent gastrectomy with lymphadenectomy of D1 + ? or more from March 2001 to December 2005 at the Korean National Cancer Center, available nodal metastasis was found in 90 pT1N1 patients. Nodal metastasis was confirmed by immunohistochemistry (IHC) with cytokeratin and patients were classified into MI and macrometastasis (MA) groups based on the main tumor burden according to the 6(th) International Union Against Cancer/American Joint Committee on Cancer staging system; the main tumor burden with a diameter of greater than 0.2 mm but no greater than 2 mm as MI, and greater than 2 mm as MA of the representative metastatic node. Proliferative and apoptotic activities of the primary tumor and the nodal metastasis were measured by IHC with Ki-67 and terminal deoxynucleotidyl transferase dUTP nick end labeling, respectively. Biopathologic and clinical features of the patients were analyzed and compared between MI and MA groups. Patients with recurrence were compared with those without recurrence to identify risk factors for recurrence.Thirty-seven patients showed MI and the other 53 patients revealed MA in the lymph node; the incidence of patients with MI and MA was 41.1% and 58.9%. The main tumor burden was 0.9 and 4.6 mm in the representative metastatic node, respectively. Japanese N2 stations were more frequently involved in MA group (20.9%) than in MI group (10.3%) but the difference was not statistically different (P = 0.338). Proliferative and apoptotic activities of MI were decreased than those of MA (26.7% vs 40.5%, P = 0.004 and 1.0% vs 3.0%, P < 0.001, respectively). However, nodal MI in the current study showed a relatively high proliferative activity and an equivalent apoptotic activity compared to other cancers in the previously published studies. Recurrence was observed in 6 patients during the mean follow up period of 87.6 ± 26.2 mo. The recurrence was significantly associated with the presence of MA (P = 0.041) and lymphovascular invasion of the primary tumor (P = 0.032).Lymphadenectomy of D1 + ? or more might be necessary in patients with MI in sentinel node to prevent recurrence by clearing MI involving Japanese N2 station.

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MDCT features in the differentiation of T4a gastric cancer from less-advanced gastric cancer: significance of the hyperattenuating serosa sign.

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